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Tiwari A, Lane J, Somani B. Litigation claims in Urology in the UK National Health Service: an analysis of the trends, costs and causes over a 16-year period. BJU Int 2024; 134:630-635. [PMID: 38967609 DOI: 10.1111/bju.16453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
OBJECTIVE To analyse the litigation trends and the reasons for claims within the specialty of Urology, within the UK National Health Service (NHS), over a 16-year period. MATERIALS AND METHODS Data were requested from NHS Resolution under the Freedom of Information Act 2000. This included the total number of claims in Urology, the number of these that were successful (settled or closed), and the costs in damages paid out per financial year between 2006 and 2022. A breakdown of the successful claims by their primary cause was also collected. These were coded into the categories: 'non-operative', 'intraoperative', 'postoperative', and 'other'. RESULTS A total of 4124 litigation claims were made between 2006 and 2022 and 60.9% (2511/4124) of these claims were successful. In all, £145 million (British pounds) was paid out in damages. The number of successful claims increased 2.9-fold from the start to end of this 16-year period, and the costs in damages paid out increased 10-fold. Regarding primary causes for the successful claims, failure or delay in treatment (20.9%, 525/2511), failure or delay in diagnosis (14.5%, 364/2511), and intraoperative problems (9.1%, 229/2511) accounted for the highest proportion. Overall, non-operative causes for successful claims accounted for 73.3% (1840/2511), intraoperative for 20.1% (504/2511), and postoperative for 3.9% (98/2511). CONCLUSIONS The number of successful urological litigation claims, and their associated costs is rising. The majority are due to non-operative causes, which may be partially explained by NHS waiting lists alongside the effects of the coronavirus disease 2019 (COVID-19) pandemic.
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Affiliation(s)
- Abhinav Tiwari
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jenni Lane
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
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Ridha MA, Ventour G, McParlin J, Cartner E, Khalid Z, Zafar AQ, Ismail A, Ross-Thriepland S. Unlocking the Potential of Underutilized Technology: A New Paradigm for Resident Doctor Efficiency. Cureus 2024; 16:e63012. [PMID: 39050337 PMCID: PMC11267489 DOI: 10.7759/cureus.63012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Background The precision of clinical documentation in trauma and orthopaedic surgery is pivotal, given its profound implications on patient care and medicolegal risks. This study assessed the impact of an autotext template intervention on the adherence of clinical documentation to the neurovascular assessment standards set by the National Institute for Health and Care Excellence (NICE) and the British Orthopaedic Association Standards for Trauma (BOAST). Methods Conducted at a single hospital, this observational study comprised two phases: a retrospective analysis of clinical documentation for 56 fracture patients (n=56) followed by the implementation of an autotext template and subsequent analysis of a new cohort of 57 patients (n=57). The intervention aimed to enhance documentation quality in line with NICE and BOAST guidelines. Results Initial findings revealed a prevalent use of the nonspecific term "NVI" (neurovascularly intact), with only 8.5% (n=5) of pre-intervention documents adhering to detailed motor function assessments and a mere 6.8% (n=4) recording limb colour. Post-intervention analysis showed a significant improvement, with 91.23% (n=52) of documents listing nerves (P < 0.001) and 96.49% (n=55) adhering to motor function documentation using the Medical Research Council (MRC) grading scale (P < 0.001). Despite these advancements, the study acknowledges potential limitations such as the Hawthorne effect and the ongoing challenge of staff rotations. Conclusion The autotext template intervention markedly enhanced the adherence to neurovascular assessment documentation standards, as evidenced by the substantial increases in detailed parameter reporting and supported by statistically significant P-values. This advancement highlights the necessity of equipping clinicians with practical tools to uphold high documentation standards amidst challenging clinical conditions. Future investigations should focus on the long-term sustainability of these improvements across varying medical staff cohorts.
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Affiliation(s)
| | | | | | - Emma Cartner
- Orthopaedics, Bradford Royal Infirmary, Bradford, GBR
| | | | | | - Ahmed Ismail
- Orthopaedics, Bradford Royal Infirmary, Bradford, GBR
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3
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Ryan PJ, Duckworth AD, McEachan JE, Jenkins PJ. The incidence of surgical intervention following a suspected scaphoid fracture. Bone Jt Open 2024; 5:312-316. [PMID: 38626919 PMCID: PMC11021995 DOI: 10.1302/2633-1462.54.bjo-2023-0059.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Aims The underlying natural history of suspected scaphoid fractures (SSFs) is unclear and assumed poor. There is an urgent requirement to develop the literature around SSFs to quantify the actual prevalence of intervention following SSF. Defining the risk of intervention following SSF may influence the need for widespread surveillance and screening of SSF injuries, and could influence medicolegal actions around missed scaphoid fractures. Methods Data on SSF were retrospectively gathered from virtual fracture clinics (VFCs) across a large Scottish Health Board over a four-year period, from 1 January 2018 to 31 December 2021. The Bluespier Electronic Patient Record System identified any surgical procedure being undertaken in relation to a scaphoid injury over the same time period. Isolating patients who underwent surgical intervention for SSF was performed by cross-referencing the unique patient Community Health Index number for patients who underwent these scaphoid procedures with those seen at VFCs for SSF over this four-year period. Results In total, 1,739 patients were identified as having had a SSF. Five patients (0.28%) underwent early open reduction and internal fixation (ORIF). One patient (0.06%) developed a nonunion and underwent ORIF with bone grafting. All six patients undergoing surgery were male (p = 0.005). The overall rate of intervention following a SSF was 0.35%. The early intervention rate in those undergoing primary MRI was one (0.36%), compared with three in those without (0.27%) (p > 0.576). Conclusion Surgical intervention was rare following a SSF and was not required in females. A primary MRI policy did not appear to be associated with any change in primary or secondary intervention. These data are the first and largest in recent literature to quantify the prevalence of surgical intervention following a SSF, and may be used to guide surveillance and screening pathways as well as define medicolegal risk involved in missing a true fracture in SSFs.
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Affiliation(s)
| | | | | | - Paul J. Jenkins
- Centre for Sustainable Delivery (CfSD), NHS Golden Jubilee, Clydebank, UK
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Hanganu CB, Isswiasi S, Adigun A, Nichita V, Sen R, Anwaar M, Drye E. Timely Review and Communication of Histopathology Reports Following Appendicectomy: Insights from a Two-Cycle Clinical Audit. Cureus 2024; 16:e58539. [PMID: 38957822 PMCID: PMC11218433 DOI: 10.7759/cureus.58539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Appendicectomy is the most frequent emergency general surgical procedure. Prior research highlights the importance of histopathology analysis after appendicectomy which is the practice in many countries including the United Kingdom (UK), aiming to prevent any oversight of vital findings and the avoidance of potential delays in patient care. Our primary objective was to audit the extent to which surgeons adhere to the NHS England patient safety guidelines from 2016 when it comes to timely reviewing and effectively communicating histopathology results to patients and/or their general practitioners following appendicectomy procedures. Our secondary objective was to amend practice, if deemed necessary, following the implementation of agreed-upon protocols, with the expected improvements being observable in the second cycle of the audit. METHODS In our two-cycle audit, we performed a retrospective analysis using online patient records from a single centre in the UK. The initial cycle involved cases of emergency appendectomies carried out consecutively for suspected appendicitis from April 2018 to June 2019. Following the clinical governance meeting and the implementation of recommendations, the second audit cycle covered cases between September 2020 and October 2020. RESULTS In the first cycle, among 418 laparoscopic appendectomies, 207 (49.52%) and 47 reports (11.24%) were reviewed within a 15-day and a 16-30-day window, respectively, following the online availability of histopathology results. Notably, 116 reports (27.75%) remained unreviewed by surgeons, and only 67 (16.02%) of these reports documented communication with patients and/or their general practitioners. In the second cycle, involving 49 patients, 38 reports (77.55%) were reviewed within the first 15 days, and 10 reports (20.4%) were reviewed between 16-30 days. Among these, 16 reports (32.65%) documented communication with patients and/or their general practitioners. CONCLUSIONS Our adherence to the aforementioned guidance was poor prior to this audit. This two-cycle audit highlighted the need for improvement in the timely review and communication of histopathology reports following appendectomy at our centre. The second cycle showed promising progress, suggesting that changes implemented between the cycles had a positive impact. Nevertheless, continuous efforts may be required to enhance and sustain adherence to these vital patient safety guidelines.
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Affiliation(s)
- Christine-Bianca Hanganu
- General Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Sanad Isswiasi
- General Surgery, West Suffolk Hospital, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR
| | - Abiodun Adigun
- Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe, GBR
| | - Vladimir Nichita
- General Surgery, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, GBR
| | - Rishi Sen
- General Surgery, West Suffolk Hospital, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR
| | - Muhammadhasan Anwaar
- General Surgery, West Suffolk Hospital, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR
| | - Elisabeth Drye
- General Surgery, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, GBR
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5
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Sebastian A, Wyld L, Morgan JL. Examining the variation in consent in general surgery. Ann R Coll Surg Engl 2024; 106:140-149. [PMID: 37218649 PMCID: PMC10830343 DOI: 10.1308/rcsann.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Consent is a fundamental aspect of surgery and expectations around the consent process have changed following the Montgomery vs Lanarkshire Health Board (2015) court ruling. This study aimed to identify trends in litigation pertaining to consent, explore variation in how consent is practised among general surgeons and identify potential causes of this variation. METHODS This mixed-methods study examined temporal variation in litigation rates relating to consent (between 2011 and 2020), using data obtained from National Health Service (NHS) Resolutions. Semi-structured clinician interviews were then conducted to gain qualitative data regarding how general surgeons take consent, their ideologies and their outlook on the recent legal changes. The quantitative component included a questionnaire survey aiming to explore these issues with a larger population to improve the generalisability of the findings. RESULTS NHS Resolutions litigation data showed a significant increase in litigation pertaining to consent following the 2015 health board ruling. The interviews demonstrated considerable variation in how surgeons approach consent. This was corroborated by the survey, which illustrated considerable variation in how consent is documented when different surgeons are presented with the same case vignette. CONCLUSION A clear increase in litigation relating to consent was seen in the post-Montgomery era, which may be due to legal precedent being established and increased awareness of these issues. Findings from this study demonstrate variability in the information patients receive. In some cases, consent practices did not adequately meet current regulations and therefore are susceptible to potential litigation. This study identifies areas for improvement in the practice of consent.
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Affiliation(s)
| | - L Wyld
- University of Sheffield Medical School, UK
| | - JL Morgan
- University of Sheffield Medical School, UK
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6
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Magowan D, Evans M, Burton L, Smith L. Medicolegal claims in general surgery: a 10-year retrospective review of claims against the NHS in England. Ann R Coll Surg Engl 2023; 105:664-671. [PMID: 36688838 PMCID: PMC10471439 DOI: 10.1308/rcsann.2022.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Every year 12,000 medicolegal claims are brought against the NHS in England at a cost of £8 billion-6.7% of the NHS England budget. In 1,000 of these claims the primary speciality is General Surgery. The aims of this paper were to examine 10 years of claims against General Surgery Departments in NHS England, identify the common causes and injuries, review the associated cost and suggest strategies for improvement. METHODS Data regarding medicolegal claims made against NHS General Surgical Departments in England from 2010 to 2020 were obtained from the Clinical Negligence Scheme for Trusts. A retrospective review was undertaken to examine the number of claims, cost of claims closed with and without damages, primary causes and primary injuries. RESULTS A total of 10,027 claims were made between 2010 and 2020. Of these, 9,377 were closed in that time, with cost totalling £851,558,930. Of claims closed, an average of 608 per year were closed with damages and 329 without damages. Claims with damages resulted in more than forty-five times greater cost per claim compared with those closed without damages. Overall, cost increased by over 50% between 2010 and 2020. Common causes included 'failure/delay in treatment', 'intraoperative problems' and 'failure/delay in diagnosis'. Common injuries included 'additional/unnecessary operation(s)', 'unnecessary pain', 'fatality' and 'bowel damage/dysfunction'. CONCLUSION Medicolegal expenditure represents a serious concern for the NHS, worsening each year. This retrospective review highlights the rising cost along with the most common causes and primary injuries. Action is required at every level of the NHS to improve surgical care, consent and communication with our patients, and by doing so minimise poor outcomes and their resultant medicolegal consequences.
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Affiliation(s)
| | | | - L Burton
- University Hospital of Wales, UK
| | - L Smith
- University Hospital of Wales, UK
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7
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Gardiner TM, Gillespie BM, Latimer S, Hewitt J. Exploring healthcare professionals' perspective of the process of obtaining consent for adult patient's having planned surgery: A scoping review. J Clin Nurs 2023; 32:5779-5792. [PMID: 37357439 DOI: 10.1111/jocn.16698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/27/2023]
Abstract
AIM The aim of this scoping review was to provide an overview of the literature about the process of obtaining consent from adult patients undergoing planned surgery from the healthcare professionals' perspective and analyse knowledge gaps. BACKGROUND The process of obtaining consent for planned elective surgery manifests an individual's fundamental right to decide what happens to their body. The process is often suboptimal and problematic, placing a significant resource burden on health systems globally. Deficiencies in the documentation on consent forms have also been shown to increase the risk of operating room error. DESIGN Scoping review. METHODS Arksey and O'Malley's (International Journal of Social Research Methodology, 8, 2005 and 19) five-step scoping review methodology was used. RESULTS Fifty-three articles were included; 39 primary and 14 secondary research publications. Three key findings were identified; there is currently low-level evidence about surgical consent processes to inform clinical practice; junior doctors obtain surgical consent frequently, yet this process was likely undertaken sub-optimally; and current knowledge gaps include capacity assessment, decision-making and pre-procedural consent checks. CONCLUSION Planned surgical consent processes are complex, and both surgeons and perioperative nurses are essential during the process. While surgeons have responsibility to obtain consent, perioperative nurses provide a safety net in the surgical consent process checking the surgical consent information is correct and has been understood by the patient. Such actions may influence consent validity and patient safety in the operating room. Knowledge gaps about capacity assessment, decision-making, pre-procedural checks and the impact of junior doctors obtaining consent on patient understanding, safety and legal claims are evident. RELEVANCE TO CLINICAL PRACTICE This review highlights the importance of the surgical nurse's role in the planned surgical consent process. While the responsibility for obtaining surgical consent lies with the surgeon, the nurse's role verifying consent information is crucial as they act as a safety net and can reduce error in the operating room. NO PATIENT OR PUBLIC CONTRIBUTION The authors declare that no patient or public contribution was made to this review in accordance with the aim to map existing literature from the healthcare professionals' perspective.
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Affiliation(s)
- Therese M Gardiner
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Southport, Queensland, Australia
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Griffith Law School, Griffith University, Southport, Queensland, Australia
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Letter to the Editor regarding Yetter et al: "Complications of articular distal humeral fracture fixation: a systematic review and meta-analysis". J Shoulder Elbow Surg 2022; 31:e462. [PMID: 35158063 DOI: 10.1016/j.jse.2022.01.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
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9
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Davenport M, Jawaid WB, Losty PD. Reply to letter to the editor regarding UK paediatric surgical academic output (2005-2020): A cause for concern? J Pediatr Surg 2022; 57:779. [PMID: 34974904 DOI: 10.1016/j.jpedsurg.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Mark Davenport
- Department of Paediatric Surgery, Kings College Hospital Foundation Trust, Denmark Hill, London SE5 9RS, UK.
| | | | - Paul D Losty
- Institute Of Life Course And Medical Sciences, University Of Liverpool, UK
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10
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Lane J, Bhome R, Somani B. National trends and cost of litigation in UK National Health Service (NHS): a specialty-specific analysis from the past decade. Scott Med J 2021; 66:168-174. [PMID: 34743634 DOI: 10.1177/00369330211052627] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Medical litigation claim and costs in UK are rising. This study aims to analyse the 10-year trend in litigation costs for individual clinical specialties in the UK from 2009/10 to 2018/19. METHODS Data were procured from National Health Service (NHS) Resolution. Number of claims, total litigation costs and cost per claim were ascertained for each financial year. The data collected also includes the number of claims and average amount per claim per speciality during the years 2009-2019 (2009/2010 to 2018/2019 financial years). RESULTS The total annual cost of NHS litigation is currently £3.6 billion(2018/2019). Damages make up the greatest proportion of costs(£1.5 billion). Surgical specialties have the greatest number of claims annually(2847) but Obstetrics has the greatest total litigation(£1.9 billion) and cost per claim(£2.6 million). Number of claims, total costs and cost per claim are significantly greater in 2018/2019 than in 2009/2010. CONCLUSIONS Addressing the issue of litigations is complex. Medically there are speciality specific issues that require attention, whilst some general measures are common to all: effective communication, setting realistic targets and maintaining a motivated, adequately staffed workforce. These, alongside legal reforms, may reduce the financial burden of increasing litigation on the NHS.
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Affiliation(s)
- Jenni Lane
- Department of Surgery, 7425University Hospitals Southampton NHS Trust, Southampton, UK
| | - Rahul Bhome
- Department of Surgery, 7425University Hospitals Southampton NHS Trust, Southampton, UK.,Faculty of Medicine, 7423University of Southampton, Somers Building, Southampton General Hospital, Southampton
| | - Bhaskar Somani
- Department of Surgery, 7425University Hospitals Southampton NHS Trust, Southampton, UK.,Faculty of Medicine, 7423University of Southampton, Somers Building, Southampton General Hospital, Southampton
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11
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Hafez AT, Omar I, Purushothaman B, Michla Y, Mahawar K. Never events in orthopaedics: A nationwide data analysis and guidance on preventative measures. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2021; 33:319-332. [PMID: 34486990 DOI: 10.3233/jrs-210051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Never Events (NE) are serious clinical incidents that are wholly preventable if appropriate institutional safeguards are in place and followed. They are often used as a surrogate of the quality of healthcare delivered by an institution. Most NEs are surgical and orthopaedic surgery is one of the most involved specialties. OBJECTIVE The aim of this study was to identify common NE themes associated with orthopaedics within the National Health Service (NHS) of England. METHOD We conducted an observational study analysing the annual NE data published by the NHS England from 2012 to 2020 to collate all orthopaedic surgery-related NE and construct relevant recurring themes. RESULTS We identified 460 orthopaedic NE out of a total of 3247 (14.16%) reported NE to NHS England. There were 206 Wrong implants/prostheses under 8 different themes. Wrong hip and knee prosthesis were the commonest "wrong implants" (n = 94; 45.63% and n = 91; 44.17% respectively). There were 197 "Wrong-site surgery" incidents in 22 different themes. The commonest of these was the laterality problems accounting for 64 (32.48%) incidents followed by 63 (31.97%) incidents of wrong spinal level interventions. There were 18 (9.13%) incidents of intervention on the wrong patients and 17 (8.62%) wrong incisions. Retained pieces of instruments were the commonest retained foreign body with 15 (26.13%) incidents. The next categories were retained drill parts and retained instruments with 13 (22.80%) incidents each. CONCLUSION We identified 47 different themes of NE specific to orthopaedic surgery. Awareness of these themes would help in their prevention. Site marking can be challenging in the presence of cast and on operating on the digits and spine. Addition of a Real-time intra-operative implant scan to the National Joint Registry can avoid wrong implant selection while Fiducial markers, intraoperative imaging, O-arm navigation, and second time-out could help prevent wrong level spinal surgery.
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Affiliation(s)
- Ahmed T Hafez
- Royal London Hospital, Barts Health NHS Trust, Shadwell, London, UK
| | - Islam Omar
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - Balaji Purushothaman
- Department of Trauma and Orthopaedic Surgery, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, UK
| | - Yusuf Michla
- Department of Trauma and Orthopaedic Surgery, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, UK
| | - Kamal Mahawar
- Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, UK.,Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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12
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O’Connell RL, Patani N, Machin JT, Briggs TWR, Irvine T, MacNeill FA. Litigation in breast surgery: unique insights from the English National Health Service experience. BJS Open 2021; 5:zraa068. [PMID: 33972991 PMCID: PMC8110893 DOI: 10.1093/bjsopen/zraa068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/09/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The increase in medical negligence claims against the National Health Service (NHS) over the past decade has had a detrimental impact on limited financial and human resources that could otherwise be available for direct clinical care. The aim of this study was to review litigation claims in breast surgery as part of the national Getting It Right First Time quality improvement initiative, with the aim of identifying opportunities to improve clinical practice and patient safety. METHODS All general and plastic surgical claims notified to NHS Resolution between April 2012 and April 2018 were reviewed. Claims related specifically to breast surgery were retrieved manually, and case summaries were analysed independently by two breast surgeons. RESULTS From 6915 claims, 449 relating to breast surgery were identified and reviewed. The mean(s.d.) claimant age was 46(13) years. The median number of claims over the 6-year period per NHS trust was 2 (range 0-22). The most frequent causes of litigation were dissatisfaction with cosmetic outcome (121 claims, 26.9 per cent) and patient-reported delays in diagnosis (121, 26.9 per cent). A large proportion of claims related to breast implant surgery (78, 17.4 per cent), and issues regarding consent/communication were common (69, 15.4 per cent). The estimated annual cost of breast surgery litigation claims ranged from £5.57 to £9.59 million (€6.35-11.02 million). CONCLUSION Patient-reported delays in diagnosis and dissatisfaction with cosmetic outcome are the most common causes of litigation related to breast surgery. These key themes should be the focus for workforce learning, with the aim of improving patient care and experience.
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Affiliation(s)
- R L O’Connell
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, London, UK
| | - N Patani
- Department of Breast Surgery, University College Hospital, London, UK
- University College London Cancer Institute, Francis Crick Institute, London, UK
| | - J T Machin
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust, Nottingham, UK
- National GIRFT programme, NHS England and Improvement, UK
| | - T W R Briggs
- National GIRFT programme, NHS England and Improvement, UK
- Sarcoma Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - T Irvine
- National GIRFT programme, NHS England and Improvement, UK
- Department of Breast Surgery, Royal Surrey County Hospital, Guildford, UK
| | - F A MacNeill
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, London, UK
- National GIRFT programme, NHS England and Improvement, UK
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13
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Lane J, Bhome R, Somani B. Urological litigation trends in the UK National Health Service: an analysis of claims over 20 years. BJU Int 2021; 128:361-365. [PMID: 33773003 DOI: 10.1111/bju.15411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To look into the urology litigation trends and successful claims in the National Health Service (NHS) over the last 20 years. METHODS We requested data from NHS Resolutions to investigate current litigation numbers, costs and causes for claims. Data collected included the number of claims dating from 1996 to 2019, the total sum of damages paid out each year for urology and the causes for the claims dating from 2009 to 2019. Data from NHS Resolutions were analysed, stratified and categorized by the authors from this information, which was provided as two separate documents. RESULTS The total cost of damages between 1997 and 2017 was £74.5m (range: £241 325-£7.8m per year). While the number of successful claims was 1653 (range 7-168 per year), the total number of claims was 3341 (range 31-347 per year) and, over time, this has increased almost sevenfold. The cost of damages has increased roughly in line with the number of claims. Over the last 10 years, non-operative-related claims accounted for 984 claims, of which the largest subset was for 'the failure to diagnose and/or treat' (n = 639, 65%), with 88 (9%) successful consent-related claims. There were 226 intra-operative-related claims. Of these, wrong-site surgery, a never-event, accounted for eight claims and there were six successful claims for failing to supervise juniors. A total of 1129 claims were postoperative claims, with retained foreign body or instrument accounting for 71 (6%) of these. CONCLUSIONS The number and cost of litigation claims have increased year on year. There is a need for continual improvement in patient care, surgical training, counselling, informed consent and early management of complications. The evidence reviewed in this paper suggests that the best approach to this is the combination of rigid adherence to and re-enforcement of common surgical guidelines and implementation of the national 'Getting it right first time' initiative.
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Affiliation(s)
- Jenni Lane
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, UK
| | - Rahul Bhome
- Department of Surgery, University Hospitals Southampton NHS Trust, Southampton, UK.,Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Bhaskar Somani
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, UK.,Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
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Griggs B, Childs T, Birkinshaw J, Badrinath P. Factors associated with wide variation in clinical litigation rates across acute NHS trusts in England: a cross-sectional analysis. Int J Qual Health Care 2021; 33:5986351. [PMID: 33201992 DOI: 10.1093/intqhc/mzaa141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/25/2020] [Accepted: 11/16/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Identify organizational factors associated with high clinical litigation rates among acute National Health Service (NHS) trusts in England. DESIGN Cross-sectional analysis using routine data. SETTING NHS trusts in England. PARTICIPANTS A total of 235 NHS trusts used the NHS Clinical Negligence Scheme in 2016-17. Ninety-seven trusts (41.3%) with no maternity services, 2 (0.9%) providing specialized services and 3 (1.2%) without clinical negligence claims were excluded. Hence, the remaining 133 trusts (56.6%) were included. INTERVENTION(S) None. MAIN OUTCOME MEASURES Rate of clinical litigation by trust per 100 000 occupied bed days. RESULTS The mean rate of clinical litigation was 25.4 per 100 000 occupied bed days. In univariable analyses, higher values of summary hospital-level mortality indictor, staff sickness, written complaints, patient safety incidents and being in the North of England led to increased clinical litigation rates. Conversely, higher patient admissions, NHS Staff Survey overall engagement score and occupied bed days led to decreased clinical litigation rates. In the multivariable model, factors associated with increased clinical litigation rates were as follows: summary mortality hospital-level indicator (SHMI) (0.9 increase in litigation rate per 0.05 increase in SHMI; P = 0.012); new written complaints (0.62 increase per 50 complaints higher; P < 0.001); located in the North of England compared to London (5.22 higher; P < 0.001). Conversely, a higher number of occupied bed days (-0.64 change per 50 000 days higher; P = 0.007) was associated with lower clinical litigation rates. CONCLUSIONS This study identified organizational factors associated with clinical litigation, which will be of interest to clinicians and the NHS. This research also highlights areas for further investigation.
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Affiliation(s)
- Beverley Griggs
- Specialty Registrar in Public Health, Public Health Suffolk, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich, Suffolk, England, IP1 2BX
| | - Tristan Childs
- Public Health Suffolk, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich, Suffolk, England, IP1 2BX
| | - Jamie Birkinshaw
- Public Health Suffolk, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich, Suffolk, England, IP1 2BX
| | - Padmanabhan Badrinath
- Consultant in Public Health Medicine, Suffolk County Council & Clinical Lecturer, University of Cambridge
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Zahra J, Paramasivan S, Blencowe NS, Cousins S, Avery K, Mathews J, Main BG, McNair AGK, Hinchliffe R, Blazeby JM, Elliott D. Discussing surgical innovation with patients: a qualitative study of surgeons' and governance representatives' views. BMJ Open 2020; 10:e035251. [PMID: 33158818 PMCID: PMC7651722 DOI: 10.1136/bmjopen-2019-035251] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 08/18/2020] [Accepted: 09/25/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Little is known about how innovative surgical procedures are introduced and discussed with patients. This qualitative study aimed to explore perspectives on information provision and consent prior to innovative surgical procedures. DESIGN Qualitative study involving semi-structured interviews. Interviews were audio recorded, transcribed and analysed thematically. PARTICIPANTS 42 interviews were conducted (26 surgeons and 16 governance representatives). SETTING Surgeons and governance representatives recruited from various surgical specialties and National Health Service (NHS) Trusts across England, UK. RESULTS Participants stated that if a procedure was innovative, patients should be provided with additional information extending beyond that given during routine surgical consultations. However, difficulty defining innovation had implications for whether patients were informed about novel components of surgery and how the procedure was introduced (ie, as part of a research study, trust approval or in routine clinical practice). Furthermore, data suggest surgeons found it difficult to establish what information is essential and how much detail is sufficient, and governance surrounding written and verbal information provision differed between NHS Trusts. Generally, surgeons believed patients held a view that 'new' was best and reported that managing these expectations could be difficult, particularly if patient views aligned with their own. CONCLUSIONS This study highlights the challenges of information provision and obtaining informed consent in the context of innovative surgery, including establishing if and how a procedure is truly innovative, determining the key information to discuss with patients, ensuring information provision is objective and balanced, and managing patient expectations and preferences. This suggests that surgeons may require support and training to discuss novel procedures with patients. Further work should capture consultations where new procedures are discussed with patients and patients' views of these information exchanges.
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Affiliation(s)
- Jesmond Zahra
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Sangeetha Paramasivan
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Natalie S Blencowe
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sian Cousins
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Kerry Avery
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Johnny Mathews
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Barry G Main
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Angus G K McNair
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- GI Surgery, North Bristol NHS Trust, Bristol, UK
| | - Robert Hinchliffe
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Vascular Services, North Bristol NHS Trust, Bristol, UK
| | - Jane M Blazeby
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- Division of Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Daisy Elliott
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, University of Bristol, Bristol, UK
- Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
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16
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Gonzales RA, Ferns G, Vorstenbosch MATM, Smith CF. Does spatial awareness training affect anatomy learning in medical students? ANATOMICAL SCIENCES EDUCATION 2020; 13:707-720. [PMID: 32048478 DOI: 10.1002/ase.1949] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
Spatial ability (SA) is the cognitive capacity to understand and mentally manipulate concepts of objects, remembering relationships among their parts and those of their surroundings. Spatial ability provides a learning advantage in science and may be useful in anatomy and technical skills in health care. This study aimed to assess the relationship between SA and anatomy scores in first- and second-year medical students. The training sessions focused on the analysis of the spatial component of objects' structure and their interaction as applied to medicine; SA was tested using the Visualization of Rotation (ROT) test. The intervention group (n = 29) received training and their pre- and post-training scores for the SA tests were compared to a control group (n = 75). Both groups improved their mean scores in the follow-up SA test (P < 0.010). There was no significant difference in SA scores between the groups for either SA test (P = 0.31, P = 0.90). The SA scores for female students were significantly lower than for male students, both at baseline and follow-up (P < 0.010). Anatomy training and assessment were administered by the anatomy department of the medical school, and examination scores were not significantly different between the two groups post-intervention (P = 0.33). However, participants with scores in the bottom quartile for SA performed worse in the anatomy questions (P < 0.001). Spatial awareness training did not improve SA or anatomy scores; however, SA may identify students who may benefit from additional academic support.
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Affiliation(s)
- Rene A Gonzales
- Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Gordon Ferns
- Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Marc A T M Vorstenbosch
- Department of Anatomy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Claire F Smith
- Department of Medical Education, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
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17
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Herron JBT, Ferris CM, Gilliam AD. Generational and occupational differences in human factors knowledge and awareness: a comparison study. BMJ Mil Health 2020; 168:372-376. [PMID: 32718977 DOI: 10.1136/bmjmilitary-2020-001487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Increasing healthcare sector litigation, accountability and governance has resulted in the identification of human factors (HF) as a common source of error. Both NHS and military doctors must have awareness of HF to enhance safety and productivity. There is limited published evidence examining knowledge of HF in these two healthcare professional groups. METHODS Doctors of all grades and specialties across the NHS and 3 military groups including the Defence Deanery within the UK were invited to complete a 10-item web-based survey. Questions focused on training undertaken, HF knowledge and potential future training needs. RESULTS The survey link was emailed to 250 military and 1400 NHS doctors, 191 military and 776 NHS responded (response rate: 76% and 55%, respectively). Military doctors above foundation trainees are more familiar with HF, have had more training and recognise a requirement for additional training. Military foundation trainees had similar responses to their NHS colleagues. Doctors who had not undertaken any HF training are less likely to appreciate its value, with almost 60% of senior NHS doctors reporting no training. Foundation trainees have more training in HF than their senior peers when military seniors are excluded and more frequently identified a need for further training. Junior doctors identified stress, fatigue, communication and leadership more frequently, with seniors identifying work environment and music in theatre correctly more often. CONCLUSION Non-training grade doctors are less likely to seek HF training. Military doctors are more familiar with HF and have undertaken more training. Given the role of HF in communication, human error, potential litigation, stress, conflict and gross negligence manslaughter convictions, further education is vital.
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Affiliation(s)
| | - C M Ferris
- Royal Victoria Infirmary, Plastic & Reconstructive Surgery, Royal Navy, Newcastle upon Tyne, UK
| | - A D Gilliam
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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18
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Nowotny BM, Davies-Tuck M, Scott B, Stewart M, Cox E, Cusack K, Fletcher M, Saar E, Farrell T, Anil S, McKinlay L, Wallace EM. Preventing critical failure. Can routinely collected data be repurposed to predict avoidable patient harm? A quantitative descriptive study. BMJ Qual Saf 2020; 30:186-194. [PMID: 31915180 DOI: 10.1136/bmjqs-2019-010141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine whether sharing of routinely collected health service performance data could have predicted a critical safety failure at an Australian maternity service. DESIGN Observational quantitative descriptive study. SETTING A public hospital maternity service in Victoria, Australia. DATA SOURCES A public health service; the Victorian state health quality and safety office-Safer Care Victoria; the Health Complaints Commission; Victorian Managed Insurance Authority; Consultative Council on Obstetric and Paediatric Mortality and Morbidity; Paediatric Infant Perinatal Emergency Retrieval; Australian Health Practitioner Regulation Agency. MAIN OUTCOME MEASURES Numbers and rates for events (activity, deaths, complaints, litigation, practitioner notifications). Correlation coefficients. RESULTS Between 2000 and 2014 annual birth numbers at the index hospital more than doubled with no change in bed capacity, to be significantly busier than similar services as determined using an independent samples t-test (p<0.001). There were 36 newborn deaths, 11 of which were considered avoidable. Pearson correlations revealed a weak but significant relationship between number of births per birth suite room birth and perinatal mortality (r2 =0.18, p=0.003). Independent samples t-tests demonstrated that the rates of emergency neonatal and perinatal transfer were both significantly lower than similar services (both p<0.001). Direct-to-service patient complaints increased ahead of recognised excess perinatal mortality. CONCLUSION While clinical activity data and direct-to-service patient complaints appear to offer promise as potential predictors of health service stress, complaints to regulators and medicolegal activity are less promising as predictors of system failure. Significant changes to how all data are handled would be required to progress such an approach to predicting health service failure.
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Affiliation(s)
- Benjamin Michael Nowotny
- Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Melbourne, Australia, Victoria, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Safer Care Victoria, Department of Health and Human Services, Melbourne, Australia, Victoria, Australia
| | - Belinda Scott
- Executive Office, Djerriwarrh Health Services, Bacchus Marsh, Victoria, Australia
| | - Michael Stewart
- PIPER, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Elizabeth Cox
- Obstetrics and Gynaecology, Monash Health, Clayton, Victoria, Australia
| | - Karen Cusack
- Executive Office, Victorian Health Complaints Commission, Melbourne, Victoria, Australia
| | - Martin Fletcher
- Executive Office, Australian Health Practitioner Regulation Agency, Melbourne, Victoria, Australia
| | - Eva Saar
- Executive Office, Australian Health Practitioner Regulation Agency, Melbourne, Victoria, Australia
| | - Tanya Farrell
- Safer Care Victoria, Department of Health and Human Services, Melbourne, Australia, Victoria, Australia.,Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Shirin Anil
- Safer Care Victoria, Department of Health and Human Services, Melbourne, Australia, Victoria, Australia
| | - Louise McKinlay
- Safer Care Victoria, Department of Health and Human Services, Melbourne, Australia, Victoria, Australia
| | - Euan M Wallace
- Obstetrics and Gynaecology, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia .,Safer Care Victoria, Department of Health and Human Services, Melbourne, Australia, Victoria, Australia
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19
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Soriano Sánchez JA, Soriano Solís S, Romero Rangel JAI. Role of the Checklist in Neurosurgery, a Realistic Perspective to "The Need for Surgical Safety Checklists in Neurosurgery Now and in the Future - a Systematic Review". World Neurosurg 2019; 134:121-122. [PMID: 31678319 DOI: 10.1016/j.wneu.2019.10.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
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20
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Camacho S. The Incorporating of 3-Dimensional Skills on Surgery Education Would Improve Curricula. J INVEST SURG 2019; 34:205-207. [PMID: 31405311 DOI: 10.1080/08941939.2019.1597953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Santiago Camacho
- Gastroenterology Service, Mexico City General Hospital 'Dr Eduardo Liceaga', Mexico City, Mexico
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21
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Chan J, Oo S. Fourteen years of litigation claims in cardiothoracic surgery in the United Kingdom National Health Service. J Card Surg 2019; 34:754-758. [DOI: 10.1111/jocs.14124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/15/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jeremy Chan
- Department of Cardiothoracic SurgeryMorriston HospitalSwansea UK
| | - Shwe Oo
- Department of Cardiothoracic SurgeryUniversity Hospital BristolBristol UK
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22
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Nowotny BM, Basnayake S, Lorenz K, Hall J, Ruddock S, Fennessy G, Cox E, Hodges R, Loh E, Wallace EM. Using medico-legal claims for quality improvement in maternity care: application and revision of an NHSLA coding taxonomy. BJOG 2019; 126:1437-1444. [PMID: 31131503 DOI: 10.1111/1471-0528.15823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To validate the NHSLA maternity claims taxonomy at the level of a single maternity service and assess its ability to direct quality improvement. DESIGN Qualitative descriptive study. SETTING Medico-legal claims between 1 January 2000 and 31 December 2016 from a maternity service in metropolitan Melbourne, Australia. POPULATION All obstetric claims and incident notifications occurring within the date range were included for analysis. METHODS De-identified claims and notifications data were derived from the files of the insurer of Victorian public health services. Data included claim date, incident date and summary, and claim cost. All reported issues were coded using the NHSLA taxonomy and the lead issue identified. MAIN OUTCOME MEASURES Rate of claims and notifications, relative frequency of issues, a revised taxonomy. RESULTS A combined total of 265 claims and incidents were reported during the 6 years. Of these 59 were excluded, leaving 198 medico-legal events for analysis (1.66 events/1000 births). The costs for all claims was $46.7 million. The most common claim issues were related to management of labour (n = 63, $17.7 million), cardiotocographic interpretation (n = 43, $24.4 million), and stillbirth (n = 35, $656,750). The original NHSLA classification was not sufficiently detailed to inform care improvement programmes. A revised taxonomy and coding flowchart is presented. CONCLUSIONS Systematic analysis of obstetric medico-legal claims data can potentially be used to inform quality and safety improvement. TWEETABLE ABSTRACT New taxonomy to target health improvement from maternity claims based on NHSLA Ten Years of Maternity Claims.
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Affiliation(s)
- B M Nowotny
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Victorian Department of Health and Human Services, Melbourne, Vic., Australia
| | | | - K Lorenz
- Victorian Bar, Melbourne, Vic., Australia
| | - J Hall
- Maryborough District Health Service, Maryborough, Vic., Australia
| | - S Ruddock
- Monash Health, Clayton, Vic., Australia
| | - G Fennessy
- Victorian Managed Insurance Authority, Melbourne, Vic., Australia
| | - E Cox
- Victorian Managed Insurance Authority, Melbourne, Vic., Australia
| | - R Hodges
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Monash Health, Clayton, Vic., Australia
| | - E Loh
- St Vincent's Health Australia, East Melbourne, Vic., Australia
| | - E M Wallace
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, The Ritchie Centre, Monash University, Clayton, Vic., Australia.,Safer Care Victoria, Victorian Department of Health and Human Services, Melbourne, Vic., Australia
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23
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Ricketts D, Roper T, Rogers B, Phadnis J, Elsayed S, Sokol D. Informed consent: the view from the trenches. Ann R Coll Surg Engl 2018; 101:44-49. [PMID: 30286630 DOI: 10.1308/rcsann.2018.0140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We review some of the recent literature on consent for surgical procedures and suggest a scheme for obtaining surgical consent.
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Affiliation(s)
- D Ricketts
- Brighton and Sussex University Hospital Trust, Royal Sussex County Hospital , Brighton, East Sussex , UK
| | - T Roper
- Brighton and Sussex University Hospital Trust, Royal Sussex County Hospital , Brighton, East Sussex , UK
| | - B Rogers
- Brighton and Sussex University Hospital Trust, Royal Sussex County Hospital , Brighton, East Sussex , UK
| | - J Phadnis
- Brighton and Sussex University Hospital Trust, Royal Sussex County Hospital , Brighton, East Sussex , UK
| | - S Elsayed
- Brighton and Sussex University Hospital Trust, Royal Sussex County Hospital , Brighton, East Sussex , UK
| | - D Sokol
- Barrister, Temple , London , UK
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24
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Valsamis EM, Thornhill C, Watson J, Khosla S, Rogers B, Ricketts D. Consenting patients for orthopaedic surgery: Is there need for change? J Perioper Pract 2018; 29:300-305. [PMID: 29932360 DOI: 10.1177/1750458918785267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An adequate consent form must be completed prior to a planned surgical procedure. Consent forms are mandatory, but the form itself does not reflect or quantify the adequacy of the discussion between surgeon and patient or the patient’s level of understanding. This study audited the adequate completion of consent forms for orthopaedic operations at a Major Trauma Centre in the United Kingdom. We also suggested recommendations regarding the completion of consent forms and proposed that tuition concerning the consent process be included as part of mandatory training for surgeons.
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Affiliation(s)
| | | | - Jay Watson
- Royal Sussex County Hospital, Brighton, UK
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25
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Cooper L, Mosahebi A, Henley M, Pandya A, Cadier M, Mercer N, Nduka C. Developing procedure-specific consent forms in plastic surgery: Lessons learnt. J Plast Reconstr Aesthet Surg 2016; 70:428-430. [PMID: 27964830 DOI: 10.1016/j.bjps.2016.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Lilli Cooper
- Queen Victoria Hospital, East Grinstead, RH19 3DZ, UK.
| | | | - Mark Henley
- Nottingham University Hospital, Nottingham NG5 1PB, UK
| | - Ankur Pandya
- Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | | | | | - Charles Nduka
- Queen Victoria Hospital, East Grinstead, RH19 3DZ, UK
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